In April 1992, a tuxedoed Bob Rafsky, eloquent spokesperson for ACT UP/New York, interrupted a black-tie fundraiser for Bill Clinton's Presidential campaign. "I'm dying of AIDS, and you're dying of ambition," shouted Rafsky, earning him -- and his demand for detailed commitments to fight AIDS -- major media coverage. This and many other protests along the campaign trail played a key role in Clinton's pre-election promise of "loud, clear and consistent" leadership in the AIDS fight, backed by specific action pledges.

Three and a half years and one fired Surgeon General after Rafsky's death early in Clinton's term, how's the chief executive doing? POZ has repeatedly documented this Administration's overall lack of AIDS leadership and specific failures on a range of issues: Refusing to lift the ban on needle exchange funding; blocking research on medicinal marijuana; and complete inaction on the White House AIDS office's own proposals to support youth with or at risk for HIV -- to name but a few.

Last December's White House Conference on AIDS featured a grand display (carefully avoiding prime-time) of sympathetic Presidential rhetoric and pledges to stand firm against Republican monstrosities. Demonstrating outside, demanding action rather than words, was a community coalition that included POZ, the National Association of PWAs, PWA Coalition/New York, Housing Works and several ACT UP chapters. The group brought a list of 50 specific steps, representing a consensus well beyond the 10 organizations that penned them, that Clinton could take to fight AIDS (POZ No. 12, p. 31). As POZ wrote then, "By using the powers of veto and executive order, each action could be taken with a stroke of the President's pen." Several were neglected proposals from Bush's AIDS Commission. Bowing to Republican Congressional control, the coalition did not even mention the many important AIDS-related bills -- such as the AIDS Cure Act, a way to redeem Clinton's 1992 promise of a "Manhattan Project" for a cure -- that he could have worked to pass, as he had when it served his campaign contributors, as the corporate-favored North American Free TradeAgreement.The coalition's recommendations were sent to the Presidential Advisory Council on HIV/AIDS. Council Chair Scott Hitt, a longtime AIDS physician and Clinton fundraiser, acknowledged at the time that our "Fifty for the Future" list included many constructive ideas. Indeed, 20 (marked by asterisks) were included, partially or fully, in the Council's own recommendations.

By July, even this Council -- filled with loyal Democrats -- was forced to conclude in a "progress report" that "when compared with what truly needs to be done, this administration's efforts are still insufficient." It particularly cited a federal prevention policy that is "underdeveloped, lacks focus and is overly timid." It also castigated what it called "officially sanctioned HIV-related discrimination" by the military, State Department and Foreign Service, which retain mandatory testing policies.

Now we have carefully reviewed the Administration's performance on the coalition's 50 proposed actions. Our findings, simplified in report-card form below (see box for grading criteria), paint a disturbing picture.

Promises to veto harmful Republican amendments have evaporated when the measures were passed as riders to other bills -- as witness welfare restrictions that will throw many PWAs off Medicaid, mandatory HIV testing of pregnant women and revocation of strong budget authority for the Office of AIDS Research (OAR). And even before the welfare bill was amended, Clinton's own proposals -- time limits and funding cuts -- (now law) were bound to produce more HIV-positive homeless people and, inevitably, more deaths.

Meanwhile, the OAR's much-vaunted blue-ribbon evaluation report -- endorsed by the Administration -- took some small steps forward on research policy proposals (only beginning to be implemented), but refused to address key issues of inappropriate drug company power and underresearched populations and treatments. Overall, Clinton's appointees have made a few recommended AIDS policy changes (often in response to activist pressure), but most items are simply stalled or, in some cases, opposed by an Administration unwilling to invest any political capital in defending the human rights of communities demonized by the right wing.

So for all the President's silver-tongued oratory about AIDS, we must give Bill Clinton an overall grade of "D+" on his actions.

45. Direct the AIDS Treatment Information Service to include information on nutrition and alternative treatments

D

PRESIDENTIAL LEADERSHIP

C

46.* Speak out against HIV-related discrimination and prejudice based on race, ethnicity or sexual orientation

F

47. Appoint a surgeon general committed to frank AIDS prevention education, needle exchange and a high profile on AIDS issues

D

48. Encourage national media to accurately report on HIV-related diseases

D

49. Direct the 46 federal agencies with arrest power to set guidelines for handling PWAs, and urge state and local authorities to adopt these guidelines

D

50. Commit to international leadership on AIDS, including implementing actions required by the Paris AIDS Summit declaration signed by the U.S., and offer to share data on federally-developed treatments and trial methodology with all countries

*Included, partially or fully, in recommendations of Presidential Advisory Council on HIV/AIDS